On the finish of final 12 months, CMS finalized a fee lower for Medicare reimbursement to physicians. The CMS Reality Sheet states:
…common cost charges underneath the PFS [Physician Fee Schedule] might be diminished by 2.93% in CY 2025, in comparison with the typical quantity these providers have been paid for many of CY 2024
This feels like a modest pay lower, however the American Medical Affiliation the true influence is even bigger. CMS experiences that the Medicare Financial Index (MEI)–a measure of apply price inflation from employees salaries and wages, workplace area, provides and malpractice–elevated by 3.5%. Thus, with reimbursement falling and apply price rising the true reimbursement discount is nearer to six.7% actual reimbursement discount.
Why is CMS doing this? MedPAC notes that CMS could also be aiming to drive down reimbursement for physicians in conventional Medicare fee-for-service with a purpose to shift them to superior various cost fashions (A-APM). Whereas the reimbursement differential between FFS and A-APM physicians is only one% in 2027, it’s going to develop to 10.5% over a number of many years.
Traditionally, the Fee has discovered that Medicare beneficiaries had comparable entry to care relative to the privately insured, however the bigger hole between MEI development and PFS updates might negatively have an effect on beneficiary entry sooner or later.
Joe Paduda agrees with this evaluation.